Provider Demographics
NPI:1932980547
Name:SWEETEN, KERADWEN MOIRA
Entity Type:Individual
Prefix:
First Name:KERADWEN
Middle Name:MOIRA
Last Name:SWEETEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERADWEN
Other - Middle Name:MOIRA
Other - Last Name:MCDOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 S WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-4639
Mailing Address - Country:US
Mailing Address - Phone:406-425-3393
Mailing Address - Fax:
Practice Address - Street 1:4700 W 69TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8757
Practice Address - Country:US
Practice Address - Phone:605-305-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant